essay on leadership in public health

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Global public health leadership: The vital element in managing global health crises

Krzysztof goniewicz.

1 Department of Security Studies, Military University of Aviation, Dęblin, Poland

Frederick M Burkle

2 Harvard Humanitarian Initiative, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA

Thomas Falconer Hall

3 AMS Support Unit, Army Medical Services, Camberley, United Kingdom

Mariusz Goniewicz

4 Department of Emergency Medicine, Interfaculty Centre for Didactics, Medical University of Lublin, Lublin, Poland

Amir Khorram-Manesh

5 Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

6 Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

The World Health Organization (WHO) and the International Health Regulations Treaty (IHRT) are responsible for modelling global public health crises, and management and mitigation of their consequences. However, both duties are delivered in all nations by their national public health systems. Therefore, the implementation of public health policies at the national level depends on the public trust of the national authorities. A trustful relationship is necessary for developing and maintaining the well-being of a community through various public health programs [ 1 ]. The principle aim of public health programs is to assess all risks, to identify underserved populations, and to initiate preventive measures, such as vaccines, non-pharmaceutical interventions (eg, social distancing, isolation) and vector control, through collaboration and coordination with other agencies and organizations, such as hospitals, schools [ 1 ]. These efforts require management authority, resources and financial support for public health and community research and sustainability of the changes they demand [ 1 ] ( Figure 1 ).

Aim of public health programs

WHO declared early in the Covid-19 pandemic that “there's no going back to normal.” This was a clear message that the existing public health infrastructure and response, seen as the “difference between life and death,” was “inadequate for the impending crisis.”

Public Health management of infectious disease outbreaks and epidemics is complex and often politically heralded in the media for a short while, with the actual voices and advocates of success largely going unnoticed. Too often, public health suffers from being a victim of its own successes, with many unaware that those major public health challenges ever existed [ 2 ]. Paradoxically, public health leaders and advocates are now facing a global pandemic with the world watching, judging, and criticizing their every move [ 2 ]. This report highlights the significant efforts that require management authority, resources and financial support for public health and community resources research and sustainability of the changes they demand.

SUCCESSFUL IMPLEMENTATION OF PUBLIC HEALTH

The key to success in the face of a public health crisis lies in prevention, preparedness, communication, and control of infectious and environmental diseases. Often called the “invisible health profession”, public health specialty is largely responsible for the majority of “improvements in global health expectancy” [ 2 ]. Developed countries expect public health to play a significant role in managing outbreaks of infectious diseases and epidemics, and overall, it has performed well. Adequate epidemiological analysis and effective preventive measures have not overwhelmed the global healthcare system allowing timely treatment of patients. As the prevalence of some diseases increase, health promotion strategies bring more resources and financial support to both local and global health resources. This was clearly evident in epidemic outbreaks of H1N1, SARS, and Ebola, to name but a few. Societies rely on public health professionals who know how to utilize resources efficiently, creating, organizing, and implementing a variety of public health strategies and programs for the benefit of the global population [ 3 ].

Public health aims to serve the whole population, recognizing that populations are not homogenous entities. Factors such as sex, race, disability, migration status and socioeconomic position can intersect to result in certain groups in society being particularly at-risk during health crises [ 2 ]. Indeed, population-based management, not individual one-on-one care, is the mainstay of public health management and success. COVID-19 pandemic has resulted in disparities in health outcomes, with the most vulnerable being disproportionately impacted throughout the pandemic [ 4 ]. Therefore, public health preparedness plans must consider the impact of a health crisis on the whole population and include underserved, vulnerable or stigmatized groups (such as undocumented migrants) [ 4 ]. The rationale for this inclusion is for both justice and enlightened self-interest; to reduce the exacerbation of existing health disparities and to optimize the collective emergency response.

The field of public health offers a multiagency and multi-professional collaboration that teaches openness and readiness for changes and challenges in the course of a disease. A public health specialist can identify threats to the health of the population, that is, threats beyond the disease of the individual patient alone [ 5 ]. Epidemiology enables the analysis of the prevalence of diseases in society and the study of the factors that influence their emergence. The most important features of a public health specialist are the willingness to search for the causes and origin of diseases and selecting appropriate tools for various tasks, communication, and cooperation in population-based teams [ 3 ]. There is a need for efficient coordination of pro-population-based health activities to prevent the consequences of disease or at least mitigate their unwanted outcomes. That is why unfairly, public health has often been labelled as a passive specialty focusing only on preventable diseases [ 6 ].

The ongoing pandemic of COVID-19 has emphasized the significance of public health as a unique specialty and its leading role in emerging public health emergencies [ 5 ]. It has also shown the importance of treating the origin of such a tumour on society and not only its metastasis. 2020 has proven to be a challenging year for public health leaders who had to go through an unimaginable crisis for which many health care systems were not prepared [ 7 ]. Collaborative efforts are crucial in managing public health crises. Epidemic control demands a response that outstrips the capacity and authority of any single organization; public health leaders, often in positions without direct authority, must therefore be skilled in influencing a coherent multi-stakeholder response [ 8 ].

In the United States, both economic and political leaders at state and national levels subsumed the leadership of public health decisions from the start, with many public health experts summarily being ignored, dismissed, threatened, or completely disregarded [ 9 ]. One in eight Americans - roughly 40 million people - lives in a community that has lost its local public health department leader during the coronavirus pandemic, all because of lack of political support or controlling political interference that prevented these leaders from making unpopular but necessary public health decisions [ 1 ]. Collectively, public health experts say the loss of expertise and experience has created a leadership vacuum in the profession [ 3 ].

Photo: From https://pixabay.com/illustrations/globe-earth-heart-rate-pulse-762008/ .

Public trust in public health agencies is an essential prerequisite for a successful response to a health crisis. Trust is required for motivating the public to undertake both voluntary action (such as vaccination uptake [ 10 ]) or to maintain compliance with legally binding regulations (such as stay-at-home orders), recognizing that government policies in free societies require the consent of the governed [ 11 ]. Public health agencies must not succumb to naive utilitarianism and instead consider the long-term consequences of individual policies on trust in the overall public health response [ 10 , 11 ]. Trustworthy public health messages are required to be scientifically based and non-political, a challenging task given inherent scientific uncertainty during health crises (which can result in policy inconsistencies) and the requirement for public health officials to work closely with politicians to deliver an effective response [ 11 ].

If there is one universal lesson that this pandemic teaches us is that a new generation of public health leadership and authority, better trained, respected, and managed, will have to be established in most communities worldwide and under a strong and independent WHO.

Resolute public health leadership at global, national and local levels has decisively influenced crisis response. At the global level, Gro Harlem Brundtland’s leadership of the WHO during SARS was characterized by swiftly galvanizing the international community to action and honestly engaging with (and at times challenging) national governments to contain the outbreak [ 12 ]. At the national level, Nigeria’s response to Ebola in 2014 saw strong political and public health leadership build on a pre-existing commitment to strengthening public health capacity to rapidly contain the outbreak, which resulted in only twenty cases and eight deaths [ 13 ]. At the local level, insight from three UK case studies identified factors grouped into “ getting started ”, “ maintaining momentum ” and “ indicators of success ” themes that contribute to success in systems leadership [ 14 ]. One of these cases was the 2018 Salisbury Novichok poisoning response. The challenges of leading this incident’s response have recently been given a wider audience through the BBC’s television drama The Salisbury Poisonings , resulting in media interest in the complexities of public health decision-making and communication [ 15 ].

On the other hand, it must be remembered that there have been cases where politicians have taken the role of scientific experts and give recommendations on which vaccines are “good” and which ones should not be taken [ 16 ]. National public health responses should outline a clear delineation between the roles and responsibilities of political leaders, who have the legitimacy and authority to lead the policy response and health officials who give medical and technical advice to officials and the public, such as the UK’s Joint Committee on Vaccination and Immunisation.

Public health emergencies will become more frequent in the future with accelerating climate changes, rapid urbanization, scarcities in food, water and energy resources, and deforestation to name but a few [ 3 ]. Public health leadership must focus on improving communication and leadership skills [ 6 ]. It cannot afford to be a passive behind the scenes profession. This must be reflected in improved quality of data, data analysis, forecasting, infrastructure improvements, a strong focus on mitigating economic and social (including racial) community-wide inequalities and improved community resilience to help public health leaders successfully move through all phases of future pandemic and global public health challenges [ 2 ].

RECOMMENDATIONS

Several measures should be implemented immediately, such as alternative local leadership and alternative facilities for care to facilitate a bid for a more flexible surge capacity to increase the four essential elements of surge capacity, ie, staff, stuff, structure, and systems [ 3 ]. A major role for Public Health and public education is a critical ingredient of a flexible response system in an age of increasing weather/climate disasters and epidemic and pandemic risks. One of the main obstacles to implementing public health policies and strategies is the low prevalence of health literacy globally. Several reports from the US, Southeast Asian countries and Europe have indicated a low or limited global health literacy, resulting in worse health care and poorer health outcomes [ 17 ]. This health literacy is consistently associated with several factors such as education, ethnicity, and age. The lack of necessary skills required to understand and manage their health does not allow the active participation of vulnerable groups in disease prevention programs [ 18 ]. Having a sustainable program guarantees public health’s continuous use to achieve its aims and population outcomes. To achieve such sustainability, public health leaders need to have the authority to evaluate whether a program is continued or halted for any reason. They also need to create systems and control measures to evaluate the benefits or outcomes of a program for its consumers. The latter requires good collaboration with the social and community-related organizations before, during and after program implementation. A course of sustained collaboration may also identify other sites in need of immediate improvement and where the program, sensitive to environmental, cultural, and socioeconomic demands, must be replicated to guarantee the long-term outcomes of the entire global program [ 3 ].

Lastly, population-based management of health crises must become a recognized health specialty which has as its core the training of future Health Crisis Managers and scientists trained across the entire “disaster cycle’ not just that of the “response phase” alone. Such recognized experts, all with a core of public health training and expertise, would become the population-based managers serving every WHO-recognized community level program [ 19 ].

CONCLUSIONS

Global crisis management demands responsible public health leadership, receptive to well-established experiences and new suggestions and exercising vocal anti-discrimination policies effectively [ 20 ]. Public health schools worldwide have to equip their students with the tools and resources they need to become effective leaders in uncertain times. They must look to not only train the best epidemiologists and biostatisticians, but also equip students with the skills and expertise to discharge public health leadership roles within the political environment. These important steps must be taken to guarantee a better future for global health and offer opportunities and new insights to health care leadership in a flexible response system [ 8 ]. With improvements in the inherent knowledge, innovation, education, and support from all emergency and non-emergency organizations, public health must be the leading specialty to build upon and create a new culture of safety and resilience at all levels of society measured by innovative priorities for action in disaster risk reduction and response [ 3 ]. If the world was able to develop global communications and air travel, it should also be eager and able to develop what we now appreciate as the future of “global public health” [ 9 ].

Acknowledgments

Disclaimer: The opinions expressed do not necessarily represent the views of the UK Defence Medical Services.

Funding: This research received no external funding.

Authorship contributions: K.G. provided the main framework, identified, and organized primary materials, and collabo-rated in writing the manuscript. A.K-M. identified appropriate references and collaborated on the writing of the manuscript. F.M.B, M.G and T.F.H. contributed to drafting sections of the manuscript. All authors have read and agreed to the published version of the manuscript.

Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author) and declare no conflicts of interest. Thomas Falconer Hall serves as a member of the UK Defence Medical Services.

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Leadership in public health

• Effective Leadership
• Published: June 2009
• Volume 24 , pages S11–S18, ( 2009 )

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• Howard K. Koh Md, MPh 1  

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The modern public health model for leadership will unlikely be the omniscient figure with easy answers.51 Rather the public health leader of the future may well be the transcendent, collaborative «servant leader» 50,52 who knits and aligns disparate voices together behind a common mission. They pinpoint passion and compassion, promote servant leadership, acknowledge the unfamiliar, the ambiguous, and the paradoxical, communicate succinctly to reframe, and understand the «public» part of public health leadership. By working between and above the levels of leadership of self, others and organizations, these transcendent leaders can ultimately shift the paradigm from «no hope» to «new hope» and create a renewed sense of community.

Such leadership will be vital as the 21st century progresses. Beginning the journey to new hope may start by motivating underdogs who nurture the spirit, discover a passion to serve, cultivate interdependence, and create uncommon bonds. These emerging leaders can tap into their unique talents, passion, and compassion to promote a mission of «the highest attainable standard of health» for all, in every community.

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Dr. Howard K. Koh was the Harvey V. Fineberg Professor of the Practice of Public Health, Associate Dean for Public Health Practice, and Director, Division of Public Health Practice, Harvard School of Public Health, Boston, MA.

Dr. Howard Koh, former Director of the Division of Public Health Practice, Harvard School of Public Health, is currently the Assistant Secretary for Health in the US Department of Health and Human Services (HHS). This article was written prior to Dr. Koh’s appointment as the Assistant Secretary for Health and does not necessarily represent the views of HHS or the United States.

This article is based, in part, on a talk delivered by Dr. Koh upon receiving the Harold Freeman Lectureship Award at the Intercultural Cancer Council’s 11th Biennial Symposium on Minorities, the Medically Underserved & Cancer in Washington DC in April 2008. Parts of the article are also drawn from a previous article «Public Health Leadership in the 21st Century« by Koh and McCormack, published in a collection of working papers by Harvard University Press in 2006.

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Dr. Bhramar Mukherjee to Receive the 2024 Marvin Zelen Leadership Award!

Currently the John D. Kalbfleisch Distinguished University Professor of Biostatistics, Chair of the Biostatistics Department, and Assistant Vice President for Research at the University of Michigan, Dr. Mukherjee is also the Siobán D. Harlow Collegiate Professor of Public Health, and Professor of Epidemiology and Global Public Health at the University of Michigan. She serves as the Associate Director for Quantitative Data Sciences at the University of Michigan Rogel Cancer Center. In addition, she is an Honorary Senior Visiting Fellow at the MRC Biostatistics Unit and an Overseas Fellow of the Churchill College of the University of Cambridge.

Dr. Mukherjee completed a Ph.D. in Statistics from Purdue University in 2001, receiving the Burr Award for outstanding doctoral student in 2001. She was Assistant Professor of Statistics at the University of Florida from 2002-2006, before joining the Biostatistics Department at Michigan. She was awarded the John G Searle Assistant Professorship in 2008 and was promoted to Associate Professor with tenure in 2009, and to Full Professor just four years later. She is currently in her eleventh year as a full professor and ninth year as a named Collegiate Professor. In 2018, she was appointed as the first female chair at the Department of Biostatistics, University of Michigan, a department that was founded in 1949. Her inspirational and visionary leadership at Michigan Biostatistics has positioned the department to thrive in the era of big data and data science.

Dr. Mukherjee is known for her work in case-control studies, gene-environment interaction, electronic health records, data integration and analysis of large-scale environmental exposure data.  Her work in statistical methodology shows an outstanding combination of breadth and depth, ranging from empirical Bayes methods and methods for shrinkage estimation, to Bayesian analysis of time series models, to methods for studying mediation and complex interactions, and causal inference. Her high-impact collaborations have included work in cancer, environmental health, and reproductive epidemiology, in addition to more recent work in infectious diseases. She has co-authored more than 380 published articles in prestigious statistics, biostatistics, epidemiology, and medical journals.

Among Dr. Mukherjee’s expansive portfolio of research, her contribution during the recent global pandemic deserves special mention. In the early days of the pandemic, Dr. Mukherjee founded the COVID-19 study group to model the virus outbreak in India. Comprising scholars at the University of Michigan, other US universities, and India, the focus of the study group was on modeling the effect of non-pharmaceutical interventions on the transmission of the virus in India.  The group used a compartmental epidemiologic model to track the virus curve and provide predictions that are updated daily.

Dr. Mukherjee has received many awards for her research in the professional world of statistics including the Gertrude Cox Award, the Adrienne Cupples Award, the Janet Norwood Award, and the Sacks Award. In 2022, she was elected to the US National Academy of Medicine, a rare achievement for a statistician.  Dr. Mukherjee is a much-sought speaker and has given over 300 invited talks on her research in the last 10 years. She has been particularly successful in obtaining research grants as principal investigator – serving as PI on nearly fifteen grants, including multiple statistical methodology grants from the NIH and the NSF. She has served as associate editor on eleven journals in statistics and epidemiology and participated in many NIH grant review panels.

Dr. Mukherjee has a remarkable record of leadership, particularly notable for her efforts to advance careers of women and underrepresented groups in statistics and data science, and to train the next generation of scholars. Dr. Mukherjee is the founding director (2015-present) of the University of Michigan’s Big Data Summer Institute for undergraduate trainees, a program supported by Rogel Cancer Center as well as an NIH R25 grant. To date, the Big Data Summer Institute has engaged and trained nearly 300 undergraduate students since it was launched; more than 50% of participants are women and more than 20% from underrepresented minority backgrounds.

The range, depth, and innovation of Dr. Mukherjee’s research contributions are exceptional among scholars in statistical science. Her exceptional work on the COVID-19 pandemic, her achievements in global health, her inspiring leadership at Michigan Biostatistics and her impactful statistical and epidemiological research, make her a worthy recipient for the Marvin Zelen Leadership Award. Most importantly, she is a dynamic and highly engaging scientist and a visionary leader who connects and builds communities, reflecting the spirit of Marvin Zelen.

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Career & Professional Events & Workshops 

Youth advisory boards are critical for ensuring public health projects that impact youth are relevant to this population, but there is limited guidance on how to form and sustain them. 

This training/workshop will be led by Baltimore youth organization HeartSmiles, providing BSPH staff, students and faculty with guidance to feel empowered to form their own youth advisory boards. This workshop provides a unique opportunity to learn directly from Baltimore youth leaders on how public health work can better center youth expertise.

Lunch included. 

Registration link -  https://cglink.me/2dh/r1951364

Part of Public Health Week 2024, hosted by the Anna Baetjer Society for Public Health Practice and sponsored by the Johns Hopkins Bloomberg School of Public Health Student Assembly.

About HeartSmiles

Born from the pain and heartache of the Freddie Gray riots, HeartSmiles is all about providing youth from underserved communities with real opportunities to succeed in life. We know that too many forgotten neighborhoods are over-run with drug addiction, crime, prostitution and low expectations for life. Not only do we provide hope for youth who want to rise above their circumstances, we provide caring mentorship, leadership skill building, access to internships, careers and more.  

Lunch included. Room TBD

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3.4 Leadership in public health

• Published: September 2009
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Imagine that tomorrow you were suddenly appointed into a prominent health leader position in your country—as a Director of Department or perhaps even Minister of Health. Upon taking office, you are presented with the following urgent dilemmas by your chief advisers:

We are suffering perennial outbreaks of water-borne diarrhoea in the urban slums of our largest city, caused by the illegal tapping of water lines. How can we prevent this in both the short and long terms?

Other departments are preventing us enacting any measures to stop smoking in public places. How can we convince them to collaborate on this critical health issue?

How can we take steps to provide anti-retrovirals for the tens of thousands of our citizens suffering from HIV/AIDS?

Our government is in moral opposition to abortion, despite scientific evidence showing that decriminalizing abortion prevents maternal deaths from sepsis. Illegal abortion is high in our country. What action should we take?

How would you proceed to address these issues? Would you be able to think on your feet and respond promptly and effectively to the health needs of your populace? In other words, are you capable of being a public health leader?

These questions are examined below as we explore the nature of leadership and the possibility of learning it.

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